Select your age group *
This field is required.
Select your age group *
Under 18
19-39
40-59
60+
Have you noticed any deterioration of your vision in the past 5 years? *
This field is required.
Have you noticed any deterioration of your vision in the past 5 years? *
Yes
No
Were your first glasses more for reading or distance? (Select all that apply) *
This field is required.
Were your first glasses more for reading or distance? (Select all that apply) *
Reading
Distance
Without my glasses and contacts (select all that apply) *
This field is required.
Without my glasses and contacts (select all that apply) *
I have trouble reading and seeing things up close
I have trouble driving and seeing things that are far away
I've been told that I have astigmatism
Describe your vision (select all that apply) *
This field is required.
Describe your vision (select all that apply) *
Blurry or cloudy
Not as colorful or vibrant as it used to be
Halos around lights and/or over-sensitivity to light
Poor at night
Double or multiple images in one eye
None of the above
* The answers to these questions will give us a general guideline as to your candidacy and expected outcome, the results of which we will provide. The only way to know the condition of your eyes is with thorough cataract medical examination.
